舒芬太尼联合丙泊酚用于无痛人流的临床效果及对人流术后宫缩痛的影响

Clinical effects of sufentanil combined with propofol on painless artificial abortion and postoperative uterine contraction pain

目的 探讨舒芬太尼联合丙泊酚用于无痛人流麻醉的效果及对人流后宫缩痛的影响.方法 选择ASA Ⅰ~Ⅱ级自愿接受无痛人流手术患者200例,随机分为观察组（舒芬太尼组）和对照组（芬太尼组）,每组100例.两组患者静注丙泊酚（1.5~2.0 mg/kg）前3 min,分别输注舒芬太尼（0.1 μg/kg）和芬太尼（0.5 μg/kg）.术中若出现体动或呻吟,酌情追加丙泊酚0.5 mg/kg.记录并比较两组患者麻醉前、术中、术后苏醒时的心率（HR）、平均动脉压（MAP）、呼吸频率（RR）及血氧饱和度（SpO2）;丙泊酚用量、麻醉苏醒时间、离院时间、醒后宫缩痛的VAS（Visual analogue scale）评分、满意程度及不良反应等.结果 与麻醉前基础值相比,所有患者在术中及麻醉苏醒后均有不同程度的呼吸抑制,表现为呼吸频率减慢,呼吸幅度减弱,其中对照组与麻醉前比较差异有统计学意义（P〈0.05）,观察组与麻醉前比较差异无统计学意义（P〉0.05）;两组患者手术中MAP均降低,其中对照组与麻醉前比较差异有统计学意义（P〈0.05）,观察组与麻醉前比较差异无统计学意义（P〉0.05）.对照组的麻醉苏醒时间和离院时间明显长于观察组（P〈0.05）,丙泊酚用量显著多于观察组（P〈0.05）.5~45 min内,观察组的VAS评分显著低于对照组（P〈0.05）.观察组术后满意度显著优于对照组（P〈0.05）.结论 舒芬太尼联合丙泊酚用于无痛人流安全有效,不良反应少,药物用量少,并能有效抑制人流术后宫缩痛,效果优于芬太尼联合丙泊酚.

[ Abstract l Objective To evaluate the clinical effects of sufentanil combined with propofol on anesthesia for induced abortion and uterine contraction pain after operation. Methods 200 ASA Ⅰ-Ⅱ volunteers of early pregnan- cy with induced abortion were randomized into control group （ fentanyl group ） and observation group （ sufentanil group） ,100 cases in each group. Sufentanil （0. 1 μg/kg） and fentanil （0. 5 p,g/kg） were respectively given to the two groups at 3 min before propofol injection （ 1.5 - 2. 0 mg/kg） , and the dosage of 0. 5 mg/kg of propofol was given according to the body movement or groan. The changes of heart rate （ HR）, mean arterial pressure （ MAP）, breath rate （RR） and oxygen saturation （SpO2 ） , total dosage of propofol, the time for emergence and leaving hospital, VAS score after abortion and adverse events were recorded and compared. Results Compared with baseline values before anesthe- sia, patients in both groups experienced varying degrees of respiratory depression manifested as the decline of respirato- ry rate and breathing amplitude, there were significant differences in control group（ P 〈 0. 05 ） , while no significant differnece was found in treatment group （ P 〉 0. 05 ）. The MAP in control groups were reduced （ P 〈 0. 05 ）. There were signifiacnt differences in the total dosage of propofol, anesthesia recovery time left, the recovery room time and VAS score at 5 - 45 rain postoperative between the two groups （ P 〈 0. 05 ）. Postoperative patient satisfaction in treatment group was significantly higher than that of control group （ P 〈 0. 05 ）. Conclusion Sufentanil combined with propofol on anesthesia for induced abortion is safe and effective, it can effectively inhibit the uterine contraction pain, and reduce the incidence of adverse effects and the total dosage of drugs, and the effects are better than fentanil combined with propofol.